MPC Contact Guide/Screening Call

Medical Expenditure Panel Survey - Household and Medical Provider Components

OMB: 0935-0118

IC ID: 204200

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

2024-07-02 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form Attachment 72 MPC Contact Guide/Screening Call Form and Instruction
Attachment 72 Attachment 72 – MPC Hospital Contact Guide Attachment 72 – MPC Hospital Contact Guide.docx Form and Instruction
Attachment 72 Attachment 72 – MPC Hospital Contact Guide Attachment 72 – MPC Hospital Contact Guide.docx Form and Instruction
Attachment 73 Attachment 73 – MPC Office-Based Doctor Contact Guide Attachment 73 – MPC Office-Based Doctor Contact Guide.docx Form and Instruction
Attachment 73 Attachment 73 – MPC Office-Based Doctor Contact Guide Attachment 73 – MPC Office-Based Doctor Contact Guide.docx Form and Instruction
Attachment 74 Attachment 74 – MPC Home Care Contact Attachment 74 – MPC Home Care Contact Guide.docx Form and Instruction
Attachment 74 Attachment 74 – MPC Home Care Contact Attachment 74 – MPC Home Care Contact Guide.docx Form and Instruction
Attachment 75 Attachment 75 – MPC Institution Contact Guide Attachment 75 – MPC Institution Contact Guide.docx Form and Instruction
Attachment 75 Attachment 75 – MPC Institution Contact Guide Attachment 75 – MPC Institution Contact Guide.docx Form and Instruction
Attachment 76 Attachment 76 – MPC Pharmacy Contact Guide Attachment 76 – MPC Pharmacy Contact Guide.docx Form and Instruction
Attachment 76 Attachment 76 – MPC Pharmacy Contact Guide Attachment 76 – MPC Pharmacy Contact Guide.docx Form and Instruction
Attachment 77 Attachment 77 – MPC Separate Billing Doctor Contact Guid Attachment 77 – MPC Separate Billing Doctor Contact Guide.docx Form and Instruction
Attachment 77 Attachment 77 – MPC Separate Billing Doctor Contact Guid Attachment 77 – MPC Separate Billing Doctor Contact Guide.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MPC Contact Guide/Screening Call	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 72	Attachment 72 – MPC Hospital Contact Guide	Attachment 72 – MPC Hospital Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 73	Attachment 73 – MPC Office-Based Doctor Contact Guide	Attachment 73 – MPC Office-Based Doctor Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 74	Attachment 74 – MPC Home Care Contact	Attachment 74 – MPC Home Care Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 75	Attachment 75 – MPC Institution Contact Guide	Attachment 75 – MPC Institution Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 76	Attachment 76 – MPC Pharmacy Contact Guide	Attachment 76 – MPC Pharmacy Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 77	Attachment 77 – MPC Separate Billing Doctor Contact Guide	Attachment 77 – MPC Separate Billing Doctor Contact Guide.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54,758	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54,758	18,160	36,598
Annual IC Time Burden (Hours)	4,563	3,343	1,220
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.